Sophie Renet

Background: Decarbonizing health systems is an urgent global priority, yet evidence on key emission drivers in oncology remains limited. We aimed to quantify the carbon footprint (CF) of injectable chemotherapy in France and identify major contributors across the care pathway.Methods: We conducted a two phase life cycle assessment (LCA). Phase 1 consisted of a process based LCA of three monoclonal antibodies—intravenous pembrolizumab, subcutaneous daratumumab, and pertuzumab–trastuzumab—administered in a Paris hospital, using cradle to grave boundaries including corporate emissions. Sensitivity analyses assessed uncertainty in manufacturing and electricity mix assumptions. Phase 2 applied an averaged LCA model across seven French hospitals to estimate the mean CF per cycle. Emissions were expressed in kg CO₂e per cycle (ISO14040/44; GHG Protocol).Findings: In phase 1, mean emissions per cycle (excluding corporate emissions) were 19·97 kg CO₂e (pembrolizumab), 42·50 kg CO₂e (daratumumab), and 30.76 kg CO₂e (pertuzumab–trastuzumab). Including corporate emissions increased totals substantially (>75% of overall impact). Results were sensitive to manufacturing assumptions, especially for high dose regimens, and electricity mix. Main contributors were pharmaceutical production, patient travel, and hospital preparation. In phase 2, mean CF per cycle across hospitals was 19·92 ± 7·98 kg CO₂e, without pharmaceutical production and corporate emissions. Interpretation: Injectable chemotherapy carries a substantial, context dependent carbon burden, driven mainly by drug production, corporate emissions, and patient travel. Comprehensive supply chain assessment is essential, and targeted clinical, operational, and industrial interventions could reduce emissions of oncology care without compromising quality. Funding: The French National Academy of Pharmacy with the French Society of Clinical Oncology Pharmacy, MSD, Johnson & Johnson, and Roche.

Purpose Remote patient monitoring of symptoms is now recommended by International oncology guidelines. In France, knowledge of real-world outcomes using telemonitoring is limited. This real-world French study aimed to evaluate the effectiveness of a telemonitoring solution in patients receiving cancer care. Methods The Continuum + Connect solution enables the sending of questionnaires and messages to the oncology team. All patients using the solution between October 1, 2021, and June 30, 2023, were eligible. Patients could respond either by themselves (Self-evaluated [SE]) or with the assistance of homecare nurses (Professionally-assisted [PA]). This retrospective real-world observational cohort study included all patients who started using the Continuum + solution during the study period. Descriptive analyses were performed. Study endpoints included conditions of use, quality of life, medication adherence, and safety outcomes. Results Overall, 1,294 patients (SE:19% PA 81%) were included. The mean age was 68.6 years (PA 71.0) and 66.9% were women (PA 63.3%). Most patients (77.3%) received treatment at home, mainly for breast, lung, or renal cancer. Compliance with telemonitoring was satisfactory. No deterioration in quality of life or treatment adherence was observed during the first 3 months of treatment. Overall, 25.3% of patients reported grade 3–4 adverse events, of which only 2.5% represented a deterioration from grade 1–2 to grade 3–4. Conclusion The Continuum + Connect is feasible and effective for the routine monitoring of symptoms, regardless of the patient’s profile. These real-world results provide useful insights and support further research.

Background: Access to accurate information in health care is a key point for caregivers to avoid medication errors, especially with the reorganization of staff and drug circuits during health crises such as the COVID‑19 pandemic. It is, therefore, the role of the hospital pharmacy to answer caregivers’ questions. Some may require the expertise of a pharmacist, some should be answered by pharmacy technicians, but others are simple and redundant, and automated responses may be provided. Objective: We aimed at developing and implementing a chatbot to answer questions from hospital caregivers about drugs and pharmacy organization 24 hours a day and to evaluate this tool. Methods: The ADDIE (Analysis, Design, Development, Implementation, and Evaluation) model was used by a multiprofessional team composed of 3 hospital pharmacists, 2 members of the Innovation and Transformation Department, and the IT service provider. Based on an analysis of the caregivers’ needs about drugs and pharmacy organization, we designed and developed a chatbot. The tool was then evaluated before its implementation into the hospital intranet. Its relevance and conversations with testers were monitored via the IT provider’s back office. Results: Needs analysis with 5 hospital pharmacists and 33 caregivers from 5 health services allowed us to identify 7 themes about drugs and pharmacy organization (such as opening hours and specific prescriptions). After a year of chatbot design and development, the test version obtained good evaluation scores: its speed was rated 8.2 out of 10, usability 8.1 out of 10, and appearance 7.5 out of 10. Testers were generally satisfied (70%) and were hoping for the content to be enhanced. Conclusions: The chatbot seems to be a relevant tool for hospital caregivers, helping them obtain reliable and verified information they need on drugs and pharmacy organization. In the context of significant mobility of nursing staff during the health crisis due to the COVID-19 pandemic, the chatbot could be a suitable tool for transmitting relevant information related to drug circuits or specific procedures. To our knowledge, this is the first time that such a tool has been designed for caregivers. Its development further continued by means of tests conducted with other users such as pharmacy technicians and via the integration of additional data before the implementation on the 2 hospital sites.

BACKGROUND Access to accurate information in health is a key point for caregivers to avoid medication errors, especially with the reorganization of staff and drugs circuits during health crises such as COVID 19. It is therefore the role of the hospital pharmacy to answer caregivers’ questions. Some may require the expertise of a pharmacist, some should be answered by pharmacy technicians, but others are simple and redundant, and automated responses may be given. OBJECTIVE We aimed at developing and implementing a chatbot to answer questions from hospital caregivers, 24 hours a day, about drugs and pharmacy organization, and evaluated this tool. METHODS The ADDIE model: Analysis, Design, Development, Implementation, Evaluation, was used by a multi-professional team composed of 3 hospital pharmacists, 2 members of the Innovation and Transformation Department, and the Information Technology (IT) service provider. Based on an analysis of the caregivers’ needs about drugs and pharmacy organization, we designed and developed a chatbot. The tool was then evaluated before the implementation into the hospital intranet. Its relevance and conversations with testers were monitored via the IT provider’s back office. RESULTS Needs analysis with 5 hospital pharmacists and 33 caregivers from 5 health services allowed us to identify 7 themes about drugs and pharmacy organization (such as opening hours and specific prescriptions). After a year of chatbot design and development, the test version obtained good evaluation scores: its speed was rated 8.2/10, usability 8.1/10, and appearance 7.5/10. Testers were generally satisfied (70%) and were hoping for the content to be enhanced. CONCLUSIONS The chatbot seems to be a relevant tool for hospital caregivers, helping them to get reliable and verified information they need on drugs and pharmacy organization. In the context of significant mobility of nursing staff during the health crisis due to COVID-19, the chatbot could be a suitable tool for transmitting relevant information related to drugs circuits or specific procedures. To our knowledge, this is the first time that such a tool has been designed for caregivers. Its development further continued by means of tests conducted with other users such as pharmacy technicians, and via the integration of additional data, before the implementation on the two hospital sites.

The COVID‐19 pandemic has focused health systems on supporting patients affected by this virus. Meanwhile in the community, many other contained patients could only use self‐care strategies, especially in countries that have set up a long and strict containment such as France. The study aimed to compare coping strategies deployed by patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS; a poorly recognised syndrome) to those with better known and referenced chronic conditions. An online flash survey was conducted during the containment period in partnership with French Patients Organizations including ME/CFS national association. Therefore, ‘Brief COPE’ version of Lazarus and Folkman's Ways of Coping Check List has been adapted to the specificity of the containment. The survey was e‐distributed in France from 15 April to 11 May 2020. Differences of coping strategies were analyzed using Wilcoxon–Mann–Withney test. Amongst 637 responses, 192 were complete, presenting a wide variety of diseases, including 93 ME/CFS. The latter have significantly different coping strategies than recognised diagnosed diseases patients: similar uses of emotion focused coping but less uses of seek social support and problem‐focused copings. In conclusion, coping strategies are different for those who deal with the daily experience of ME/CFS, highly disabling chronic condition with diagnostic ambiguity, low degree of medical and social recognition and without treatment. Better understanding of those strategies is needed to provide the means for health promotion researchers, managers and clinicians, to accompany those patients.

Background Oral anticoagulants are widely used for treatment and prevention of thromboembolic diseases. We set up a pharmaceutical counseling program for both direct oral anticoagulant and vitamin K antagonist drugs in our hospital in 2015. Objective Evaluate patient satisfaction and the evolution of their knowledge throughout the pharmaceutical counseling program on anticoagulants and identify knowledge variability factors. Setting Cardiology Inpatient Unit from the University Antoine Béclère Hospital, France. Methods Evaluation was based on data collection of patients surveyed between 2015 and 2018. Inpatients in the cardiology department on oral anticoagulants were eligible. The learning process was designed to enhance patient knowledge and understanding based on 10 cognitive or self-management skills, relating to the optimization of oral anticoagulant therapy management. It consisted in 2 face-to-face interviews during hospitalization and 2 additional phone interviews one and six months after discharge. The median patient score was evaluated at each step of the process as well as the mean score for each item from the global population. A sub-analysis was run on the less well-acquired skills in order to identify risk factors for limited knowledge. The association between those factors and the level of knowledge (score ≥ 7 or < 7) was assessed using Chi square test followed by multivariate analysis. Main outcome measure Patient knowledge of anticoagulation therapy depending on specific factors. Results Of the 880 patients eligible for pharmaceutical counseling, 319 entered the process and 102 completed it. Median knowledge scores were 8/10 and 9/10 after the first and the final interviews respectively with a significant improvement (p = 0.0003). The least well-acquired items at each step were surveillance and under-dosing management. The sub-analysis showed the use of vitamin K antagonist to be linked to an enhanced understanding related to treatment surveillance (p = 0.029). Patients suffering from atrial fibrillation were found to have a worse understanding of under-dosing management (p = 0.013). Finally, patients evaluated the process as helpful and suitable for their conditions. Conclusion Pharmaceutical counseling is appropriate for patients, improving and maintaining knowledge of oral anticoagulants. Our evaluation highlights the need to focus on patient-specific profiles to reach a satisfactory level of knowledge.